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Yes, a single-payer system would save money, but you have to be honest about the downsides. It's unfortunate that they are not honestly discussed in the article

Yes, a single-payer system would save money, but you have to be honest about the downsides. It's unfortunate that they are not honestly discussed in the article. Or, for that matter, almost anywhere. The vast majority of the savings come from government price fixing. This is what the article means by "large government entities are able to negotiate much more favorable terms with service providers." It's not really a negotiation; at least not like it is in the private sector. When the government controls an entire market, they set prices. They can (and should) take input from providers and drug/device developers, but at the end of the day, whatever they say goes. There are incredible risks when the government sets prices for a good/service. We should not take on those risks lightly.

jellicle 9y ago
Suppose the current price for "two tylenol handed to a patient in a paper cup" is $50, and a giant insurer^W^W EVIL GOVERNMENT says it will only pay $40 next year. What do you suppose will happen? Societal collapse?
- camiller 9y ago
  I suppose the hospital will lay off a pharmacist, increasing the workload for the rest of the pharmacy team, and instead of your Tylenol showing up in 15 min it will show up in 45 min.
ClassyJacket 9y ago
How does a government control an entire market when private health insurance is still available?
exelius 9y ago
Pricing in health care is currently not a negotiation. The customer often doesn't know the price before services are rendered -- they're left to negotiate the bill after the fact. And in the case of life-saving care like chemotherapy, your choice is "pay or die". That's not a negotiation; that's an ultimatum.
esturk 9y ago
You rip NYT for not openly discussing the downsides, yet after reading your comment about the 'risks', you haven't talked about the downsides either. Aside from "negotiation is not negotiation in the private sector", you aren't adding much to the discussion. Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate.
- makomk 9y ago
  One of the risks is that the doctors and nurses you need to actually provide the healthcare will find work elsewhere that actually pays them well. This seems to be happening to a certain extent in the UK right now.
- methodover 9y ago
  I'm not really an expert at all either when it comes to healthcare or economics. I feel not particularly qualified to get into the downsides. I'm just a regular person trying to understand the debate and take an informed position. That said, I'll try and take a stab at answering your comment in an honest way. > Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate. When the government owns an entire industry (as is being proposed in this case with the health insurance industry) I'm not sure if there is any meaningful difference between the sentences, "the government will set a price" and "the government will negotiate a price with providers." We are talking about price controls as a means of lowering prices. It seems to be about that simple. I'm a bit confused by what you mean when you say that when the government does it, "it doesn't make it any less legitimate." I'm not arguing about it would be illegitimate or unlawful of the government to set prices. I am, however, suggesting that there are known negative consequences of government price controls. The general criticism of price controls, as I understand it, is that when the government sets prices too low, it causes shortages. Applied to healthcare, I would imagine that we risk slower development of new drugs and devices, lower quality service from doctors and nurses, and shortages of drugs and devices.

jellicle 9y ago

Suppose the current price for "two tylenol handed to a patient in a paper cup" is $50, and a giant insurer^W^W EVIL GOVERNMENT says it will only pay $40 next year. What do you suppose will happen? Societal collapse?

camiller 9y ago
I suppose the hospital will lay off a pharmacist, increasing the workload for the rest of the pharmacy team, and instead of your Tylenol showing up in 15 min it will show up in 45 min.

ClassyJacket 9y ago

How does a government control an entire market when private health insurance is still available?

exelius 9y ago

Pricing in health care is currently not a negotiation. The customer often doesn't know the price before services are rendered -- they're left to negotiate the bill after the fact. And in the case of life-saving care like chemotherapy, your choice is "pay or die". That's not a negotiation; that's an ultimatum.

esturk 9y ago

You rip NYT for not openly discussing the downsides, yet after reading your comment about the 'risks', you haven't talked about the downsides either. Aside from "negotiation is not negotiation in the private sector", you aren't adding much to the discussion. Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate.

makomk 9y ago
One of the risks is that the doctors and nurses you need to actually provide the healthcare will find work elsewhere that actually pays them well. This seems to be happening to a certain extent in the UK right now.
methodover 9y ago
I'm not really an expert at all either when it comes to healthcare or economics. I feel not particularly qualified to get into the downsides. I'm just a regular person trying to understand the debate and take an informed position. That said, I'll try and take a stab at answering your comment in an honest way. > Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate. When the government owns an entire industry (as is being proposed in this case with the health insurance industry) I'm not sure if there is any meaningful difference between the sentences, "the government will set a price" and "the government will negotiate a price with providers." We are talking about price controls as a means of lowering prices. It seems to be about that simple. I'm a bit confused by what you mean when you say that when the government does it, "it doesn't make it any less legitimate." I'm not arguing about it would be illegitimate or unlawful of the government to set prices. I am, however, suggesting that there are known negative consequences of government price controls. The general criticism of price controls, as I understand it, is that when the government sets prices too low, it causes shortages. Applied to healthcare, I would imagine that we risk slower development of new drugs and devices, lower quality service from doctors and nurses, and shortages of drugs and devices.